M11: Face And Neck Flashcards
When does development of the face occur, when is it complete
5 wks LMP
10 wks
What does the face develop from
5 main facial processes that move together and fuse:
1 frontonasal process
2 maxillary prominences
2 mandibular prominences
How does the frontonasal process of the face develop
What does it form
Starts superior and move inferiorly
Mid forehead, nose, central upper lip, central maxilla and anterior palate
Another name for anterior palate
Primary palate
How does the maxillary and mandibular prominences of the face develop
What do they form
Maxillary moves medially And fuse to form:
Cheeks
Lateral upper lip
Maxilla
Secondary palate
Mandible fuse to form the mandible
Another name for Secondary palate
Posterior palate
Describe the migration of the nose where does it start
Starts above the orbits as 2 widely spread nasal placodes that move medially and inferiorly
Define placodes
Areas of ectoderm tissues that form the sense organs
Describe the migration of the eyes
Where do they start
Start laterally and move medially
Describe the migration of the ears
Where do they start
Below the mandible and move laterally and upwards
Are facial anomalies common
What do they often cause
Yes
Polyhydramnios
facial anomalies are associated w/ what other anomalies
Other non-facial anomalies due to chromosomal abnorm.
What drugs/teratogens can affect the development of the face
Alcohol
Codeine
Valium
Anti-epileptics
Which chromo abnorm is commonly associated w facial anomalies
T13, then T18
What view do we assess the orbital distance, the lens and binocular distance
Axial view/BPD with the orbits and cranium in view
Which view is used to assess the nose/lips
What are we assessing for
Tangential coronal… important to have the soft tissues, not the bone
Intact upper lip
Presence of 2 nostrils
What do we asses for when scanning the profile
Prominence of chin and forehead
Protruding tongue or flattened nose
Assess for nasal bone
How should the alignment of the bones appear in the profile image
What about the forehead
Maxilla, nasal bone, chin
Forehead shouldn’t extend out to the same level of the other bones
When assessing the profile, how should the chin be positioned
Off the chest
Propose of 3D imaging
Give parents and surgeons an idea of what to expect at birth
How far apart should the orbits be
Separated by a distance of 1 orbit
Which measurement for the orbits can be used to date preg when BPD cant be obtained
Outer orbital distance
Describe anophthalmia
Congenital absence or severe hypoplasia or the eyes
LOOK FOR LENS
anophthalmia is associated w/ which chromo abnorm
T13
Describe micophthalmia
Which measurement is important
Small eyes
Interocular measurement
micophthalmia is associated w/ which chromo abnorm
T13
Describe hypertelorism
What commonly causes it
Other causes
Widely spread eyes
Mass blocking anterior migration of the eyes
Craniosynostoses , eyes cant migrate
Describe hypotelorism
Which measurement if important
Associated w/ which chromo abnorm
Eyes close together
Binocular measurement
T13
Describe cyclopia
Associated w/ which abnorm of the nose
Asssociated w/ which chromo abnorm
Fusion of eyes into one orbit
supraorbital proboscis
T13
Describe ethmocephaly
2 closely spaced but separate eyes w/ a supraorbital proboscis
Describe cebocephaly
2 closely spaced but separate eyes w/ a centrally placed nose w/ only one blind ended nostril
What is a proboscis
Tuft of tissue, usually above the eyes… no normal nose
5 patterns of cleft lip and palate
more cases are what type
isolated cleft lip unilateral cleft lip and palate bilateral cleft lip and palate midline cleft lip and palate facial defects associate w/ amniotic bands
cleft lip and palate together
is US better at detecting cleft lip or palate
lip, palate is hard to see on US and often missed
which type of cleft lip is more likely to be associated w/ additional anomalies
isolated cleft lip
2 abnormalities often seen w/ clefting
polyhydramnios and sm stomach b/w the defect can disturb swallowing
cleft lip should not be confused w/ which normal anatomy
philtrum
lateral cleft lip is associated w/ which chromo abnormality
T18
US appearance of bilateral cleft lip
snout like appearance b/c upper lip isn’t attached on either side on the mouth so ‘floats’ in the amniotic fluid
median cleft face has a stronger association w/ which chromo abnorm
T13
describe median cleft face
which structures didn’t fuse to cause this
cleft in the middle of the nose and including the nose (missing the septum)
nasal and maxillary structures failed to fuse
best view to assess for cleft palate
look around which area in the mouth?
TRX
around tooth buds
cleft palate can be mistaken for which normal facial structures
oral cavity or ethmoid sinuses
describe macroglossia
associate w/ which chromo abnorm
abnormally large protruding tongue beyond the lips
T21 and beckwith-wiedemann syndrome
abnormalities seen w/ beckwith-wiedemann syndrome
macroglossia macrosomia (big baby) omphalocele renal hyperplasia or dysplasia increased risk of wilms tumor and hepatoblastoma
define micrognathia
retrognathia
small chin
receding chin
what is frontal bossing
associated w/ what anomalies
protruding forehead
skeletal dysplasia
low set and/or small ears are associated w/ which abnormalities
T21, 18 or 13
when does the thyroid start to function
what abnormalities can occur
12 wks
hyper or hypothyroidism
maternal causes of hyperthyroidism in the fetus
maternal graves disease
Us appearance of hyper or hypothyroidism
- thyroid would be enlarged, neck mass is seen that may cause the fetal neck to be hyperextended
- polyhydramnios due to obstruction
what can fetal thyroid dysfunction lead to
treatment
IUGR
oligohydramnios
tachycardia
thyroid medicaltion administered to mom
what is a nuchal cord
umbilical cord wrapped 2 or more times around the neck…
more likely to be a poor prognosis if the cord it wrapped multiple times and tightly… loose wrapping or 1 loop is insignificant
best plane to assess nuchal cord
TRX
describe cystic hygroma
prognosis
separated nuchal fluid located posterior and lateral to the neck… usually multiocular lymph fluid lined by lymphatic endothelium
poor
how does a cystic hygroma arise
thought to arise due to a failure of the lymphatic sys to develop a communication to the venous sys of the neck…. so lymph can’t drain properly.
are all cystic hygromas lymphatic in origin
no
cystic hygroma associations
hydrops chromo abnormalities (>60%) cardiac abnormalities fetal alcohol syndrome can be seen after IUD
cystic hygroma is associated w/ which chromo and genetic abnorm
turners
T21
noonan syndrome
US appearance of cystic hygroma
when can they be seen
hypo fluid w/ random septations
as early as 10 wks
cystic hygroma can be mistaken of which normal anatomy
nuchal translucency
Ddx for cystic hygroma
poster encephalocele, but brain, skull, spine are all normal w/ cystic hygroma
when is the nuchal translucency seen
how big is the CRL at this time
normal value
11-13 wks and 6d gestation
45-84 mm
< 3mm but depends on maternal age
increased size of nuchal T associated w/ abnormalities
chromosomal and other abnormalities
how do you measure a NT
zoom, only head and fetal chest on the screen perfect midline sag neutral spinal/chin position decrease compression measure on to on
when is the nuchal fold (NF) assessed
what causes it to be thick
16-24 wks for T21
subcutaneous edema
when do we stop measuring nuchal fold
24 weeks, after this babies have different growth curves so could be larger but norm
what positioning can help visualize the NF better
tip posterior of babies head anteriorly
what are teratomas composed of
can they obstruct swelling
3 germ cell layers
yes
what is dystocia? what can cause it
difficult labor/birth
teratoma
what affects can a teratoma have after birth
compromised breathing and swallowing
US appearance of teratoma
solid mass, hyperextension of the fetal neck if the mass is big
With hypertelorism, which eye measurements are normal and which are abnormal
N: OOD
AB: IOD
